Podiatry Coding & Billing Alert

Edits affecting podiatry generally involve debridement and ultrasound.

When you're reviewing this year's first serving of Correct Coding Initiative (CCI) edits, keep in mind that deletions are just as important as new bundling edits. Watch out for plenty of retiring pairs in CCI Edits' version 17.0 that apply to podiatry.

Background: The latest version of Correct Coding Initiative edits (CCI 17.0) takes effect Jan. 1. This quarter's release include 19,790 additions (227 mutually exclusive and 19,563 nonmutually exclusive). Additionally, CCI 17.0 clarifies 9,732 deletions (204 from the mutually exclusive pack and 9,528 from the nonmutually exclusive).

11040, 11041, 76880: Let Go of Noncovered Pairings

CCI Edits 17.0 contain the deletion of bundles involving debridement codes 11040 (Debridement; skin, partialthickness) and 11041 (Debridement; skin, full thickness). Some of these deletions bundle procedures that affect podiatry, including:

• 11730 -- Avulsion of nail plate, partial or complete, simple; single
• 11750 -- Excision of nail and nail matrix, partial or complete (e.g., ingrown or deformed nail), for permanent removal
• 11752 -- ...with amputation of tuft of distal phalanx
• 11760 -- Repair of nail bed
• 11762 -- Reconstruction of nail bed with graft
• 12001 -- Simple rapair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremeties (including hands and feet); 2.5 cm or less
• 12002 -- ...2.6 cm to 7.5 cm
• 12004 -- 7.6 cm to 12.5 cm.

The deletions also include ultrasound code 76880 (Ultrasound, extremity, nonvascular, real time with image documentation) as component of several procedures, including:

• 28890 -- Extracorporeal shock wave, high energy, performed by a physician, requiringanesthesia other than local, including ultrasound guidance, involving the plantar fascia
• 77418 -- Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session.

CCI deleted bundles with 11040, 11041 and 76880 because CPT 2011 has removed these codes from its list beginning Jan. 1. It only makes sense that CCI no longer include any pairings with these nonexistent codes.

97597, 97598 Debut With Podiatry-Related NME Pairings

Other main edits you want to be sure to watch for are related to revised debridement codes:

• 97597 -- Debridement [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm], including topical application[s], wound assessment, use of a whirlpool, when performed and instruction[s] for ongoing care, per session, total wound[s] surface area; first 20 sq cm or less)
• 97598 -- Debridement [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm], including topical application[s], wound assessment, use of a whirlpool, when performed and instruction[s] for ongoing care, per session, total wound[s] surface area; each additional 20 sq cm, or part thereof [List separately in addition to code for primary procedure])
• New ultrasound codes 76881 (Ultrasound, extremity, nonvascular, real-time with image documentation; complete) and 76882 (Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific).

CCI Edits 17.0 includes non-mutually exclusive edits for component procedures when performed with 97597. These include:

• 20551 -- Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")
• 20552 -- Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
• 20553 -- ...single or multiple trigger point(s), 3 or more muscle(s)
• 26340 -- Manipulation, finger point, under anesthesia, each joint
• 29345 -- Application of long leg cast (thigh to toes)
• 29405 --Application of short leg cast (below knee to toes)
• 29425 -- ...walking or ambulatory type
• 29515 -- Application of short leg splint (calf to foot)
• 29540 -- Strapping; ankle and/or foot
• 29550 -- ...toes
• 29590 -- Denis-Browne splint strapping.

Tip: Non-mutually exclusive (NME) codes are services that physicians often perform during the same session that are not billable together, with one as the comprehensiveor larger procedure and the other as the component. The component code is included in the services represented by the comprehensive code.

Stop Coding 97597 With Surgical Preparation and Repair/Reconstruction Codes

CCI 17.0 lists as being mutually exclusive the following codes:

• 97597 and 28289 (Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint)
• 15004 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar [including subcutaneous tissues], or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1 percent of body area of infants and children) and
• 97597.

You would use 97597 for active wound care; 28289 for removal of bone for a hallux rigidus procedure; and 15004 for preparing a wound site to receive some type of skin graft, says Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va. CPT 28289 doesn't involve a wound, he adds.

What ME means: When codes are mutually exclusive, they are codes that should not be billed together due to conflicting CPT definitions or "the medical impossibility/improbability that the procedures could be performed at the same session," CCI states. Although these codes technically are not bundled, they should not typically be reported on a single claim. When you report codes identified as mutually exclusive for a single surgical session, usually the carrier will recognize and reimburse only the lesser-valued procedure.